<!DOCTYPE html>
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<html> 
<head>
        <title>Cita_Administrativo</title>
        <meta charset="UTF-8">
        <meta name="viewport" content="width=device-width, initial-scale=1.0">
    </head>
    <body>
        <table>
            <tr>
                <td>Dni</td>
                <td><input type="text" size="40" name="Dni"></td> 
                <td>Nombre</td>
                <td><input type="text" size="40" name="Nombre"></td> 
            </tr>
            
            <tr>
                <td>Apellidos</td>
                <td><input type="text" size="40" name="Apellidos"> </td>
                <td><input type="checkbox" name="hospital" value="cita_solicita_presencial" /> Solicitada_Presencial<br> </td>
           
           </tr>
           <tr>
           		<td>Especialidad : </td>
           		<td><select multiple size="1" name="Especialidad">
				<option value="Padiatria">Padiatria</option>
				<option value="Oncologia">Oncologia</option>
				<option value="Traumatologia">Traumatologia</option>
				<option value="Neurologia">Neurologia</option>
				<option value="Nutriología">Nutriología</option>
				<option value="Reumatología">Reumatología</option>
				<option value="Neumología">Neumología</option></td>
           </tr>
           <tr>
           		<td>Médico :</td>
           		<td><select multiple size="1" name="Especialidad">
				<option value="José Garcia Martin ">José Garcia Martin</option>
				<option value="Andres Fernandez Rivas">Andres Fernandez Rivas</option>
				<option value="Joaquin Martin Soto">Joaquin Martin Soto</option>
				<option value="Francisco Soto Lopez">Francisco Soto Lopez</option>
				<option value="Alberto Maldonado Garcia">Alberto Maldonado Garcia</option>
				<option value="Jesus Martin Lopez ">Jesus Martin Lopez</option>
				<option value="Mercedes Fernandez Rivas">Mercedes Fernandez Rivas</option></td>
           </tr>
            <tr>
           		<td>Fecha :</td>
           		<td><select multiple size="1" name="Fecha">
				<option value="19/10/2014">19/10/2014</option>
				<option value="02/07/2014">02/07/2014</option>
				<option value="23/05/2014">23/03/2014</option>
				<option value="16/11/2014">16/11/2014</option>
				<option value="03/09/2014">03/09/2014</option>
				<option value="14/06/2014">14/06/2014</option>
				<option value="08/09/2014">08/09/2014</option></td>
           </tr>
           <tr>
           		<td><input type="submit" value="Añadir cita"></td> 
           		<td><input type="button" value="Consultar cita" /></td>
           		<td><input type="button" value="Modificar Cita" /></td>
           </tr>
            
        </table>
        
    </body>
</html>